Laryngomalacia

What is stridor? Stridor is the sound produced by turbulent flow of air through a narrowed segment of the respiratory tract. It is a sign of airway obstruction in a child. It typically originates from the larynx (voice box) or trachea (windpipe). The larynx functions as a passage for breathing, an organ of communication, and as a protective valve to prevent foreign objects including food and water from entering the lungs. Infections or abnormalites of the larynx can produce symptoms and signs of airflow obstruction, altered phonation, and/or feeding difficulty.

Normal Larynx: showing the upside down "v" of the vocal cords, and the pale edge of the curved epiglottis at the top of the picture	Severe laryngomalacia: The epiglottis is rolled in from side to side, and the arytenoid mucosa is pulled into the larynx during inspiration

Laryngomalacia: Summary of characteristics

• begins within the first few days of life or up to 2 months (but not at birth)
• louder on inspiration (breathing in)
• worse with crying, upper respiratory tract infections (URTI), supine (on back) position with neck flexed forward
• better in prone position with neck hyperextended (chin up)
• may be accompanied by:
  • significant inspiratory retractions (caving end of tissues above or below the ribs when breathing in...due to blockage of air flow)
  • normal voice or varying degrees of hoarseness
• may worsen over the first few months of life before improving

Is laryngomalacia a dangerous condition? It is usually a benign self-limiting condition, which does not interfere with a child’s growth and development. However, if the airway obstruction is severe as manifested by cyanosis (blue spells), inward collapse of the chest wall and retraction of the costal margins during inspiration, difficulty in feeding causing failure to thrive, and secondary heart failure, it could lead to asphyxiation and death.

How is laryngomalacia managed? The physician after a detailed evaluation will categorize the severity of the condition as being mild, moderate, or severe. Mild symptoms and signs may be managed by periodic observation only. Moderate obstruction will in addition require home monitoring of breathing and heart rate and a more detailed assessment. Severe conditions may require hospitalization, intensive care monitoring and a surgical procedure to relieve obstruction and correct the functional abnormality.